Pediatric Gastrointestinal Endoscopic Sedation: A 2010 Nationwide Survey in Taiwan

Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan.
Pediatrics & Neonatology (Impact Factor: 1.23). 06/2012; 53(3):188-92. DOI: 10.1016/j.pedneo.2012.04.006
Source: PubMed

ABSTRACT There is insufficient data on pediatric endoscopic sedation practices worldwide. This study aimed to assess nationwide data on the current pediatric endoscopic sedation practices in Taiwan.
Members of the Taiwan Society of Pediatric Gastroenterology Hepatology and Nutrition in 2010 were asked to participate in an 18-item questionnaire survey regarding current sedation practices for diagnostic esophagogastric-duodenoscopy (EGD).
A total of 22 of 32 questionnaires were returned for a response rate of 68.8%. A majority (86.4%) of the respondents practiced in a medical center hospital setting, and 72.7% preferred sedation during EGD. The proportions of respondents applying sedative methods in cases aged < 1, 1∼12, and > 12 years old were 85.7%, 100%, and 23.7% respectively. Ketamine (27.8%) and midazolam with meperidine (22.2%) were the most commonly applied sedation agents, while the percentage of respondents using regimens that included propofol was 11.2%. Comparing complications between EGD with and without sedation, only hypoxia (Wilcoxon statistics=347.00, p=0.003) was significantly more common in sedated patients. The endoscopists' satisfaction rating was greater among respondents using sedation compared to those without (visual analog scale 9 vs. 7; p=0.0001).
A majority of pediatric EGD in Taiwan was performed under sedation and applied more often to younger children. Endoscopists were more satisfied during EGD when practicing sedation. This survey should help formulate updated practice guidelines and policies regarding endoscopic sedation.

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    • "Availability of specific antagonists for these agents is the attractive point when using these medications. For these reasons, midazolam alone or midazolam/opioid combination is strongly preferred by gastroenterologists [27,28,29,30]. However, benzodiazepine/opioid combination has relatively long time to achieve adequate sedation, procedure, and recovery [31]. "
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    ABSTRACT: To present evidence and formulate recommendations for sedation in pediatric gastrointestinal (GI) endoscopy by non-anesthesiologists. The databases MEDLINE, Cochrane and EMBASE were searched for the following keywords "endoscopy, GI", "endoscopy, digestive system" AND "sedation", "conscious sedation", "moderate sedation", "deep sedation" and "hypnotics and sedatives" for publications in English restricted to the pediatric age. We searched additional information published between January 2011 and January 2014. Searches for (upper) GI endoscopy sedation in pediatrics and sedation guidelines by non-anesthesiologists for the adult population were performed. From the available studies three sedation protocols are highlighted. Propofol, which seems to offer the best balance between efficacy and safety is rarely used by non-anesthesiologists mainly because of legal restrictions. Ketamine and a combination of a benzodiazepine and an opioid are more frequently used. Data regarding other sedatives, anesthetics and adjuvant medications used for pediatric GI endoscopy are also presented. General anesthesia by a multidisciplinary team led by an anesthesiologist is preferred. The creation of sedation teams led by non-anesthesiologists and a careful selection of anesthetic drugs may offer an alternative, but should be in line with national legislation and institutional regulations.
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